Sports Concussions: Are your kids at risk?

by Lou Fancher Correspondent Walnut Creek Magazine

FINALLY THERE’S GOOD NEWS ABOUT CONCUSSIONS AND YOUTH ATHLETICS. The full weight of medical research, better-informed coaches, legislative action, parental and patient insights and professional head injury prevention coalitions is catapulting its way into the subject’s historic, “man-up and shut up” mentality. Even more remarkable, as the pendulum swings from hiding to hysteria—ironically, caused by better reporting—science and a slowly evolving culture are bring- ing calm rationality to the turbulent voices. And a considerable amount of the activity is happening right here in the East Bay. The Walnut Creek-based California Concussion Coalition (CCC) is partnering with the Sports Legacy Institute (SLI), a Boston-based non-profit brain trauma research and prevention center, to provide concussion prevention training in the Bay Area. Founded by Eric Freitag, a licensed clinical psychologist and board certified neuropsychologist with experience working with Traumatic Brain Injury (TBI) athletes and at-risk populations, CCC is out to educate. Since their inception in 2012, Freitag and a band of medical providers, professional athletes and athletic trainers, have led workshops and conferences with the purpose of adding velocity to the painstakingly slow shift in the concussion conversation. Admittedly, bad news accompanies the good news CCC dispenses: it seems the more we know about concussions, the more we know how much we don’t know. Although head injuries are no longer only the purview of football (hockey, soccer, lacrosse, wrestling, boxing and basketball are on the list), experts know that specific populations remain vulnerable. A 2010 National Athletic Trainers Association study showed female basketball players’ concussions were three times higher than that of their male peers. Anecdotally, coaches report similar findings. Whether the higher statistics are attributable to female athletes’ increased participation or the fact they are more willing to report symptoms, the numbers are cause for concern. And while telemetric helmets and mouth guards, able to transmit wireless signals about the impact of a head hit to computers are promising technologies, they remain in early development and expensive. Experts say helmets are crucial for preventing skull fractures, but emphasize the reality: helmets do not eliminate concussions. Two California bills, AB 1451 and AB 25, require all California high school coaches to receive concussion education and issue strict return-to-play guidelines for athletes. Although saluted as “first steps” by medical professionals, criticism of the bills’ “lack of teeth,” in the form of enforcement standards and penalties, is common. THE DOCTORS Freitag’s lanky well-over-six-foot frame suggests an athlete. A former collegiate soccer player and a USSF licensed soccer coach, he says the CCC’s first season proves the organization’s importance.“We did an all day provider symposium with Kaiser that sold out,” he says. “At a recent workshop at Miramonte High School we had 75 people.” Having suffered two concussions during his playing days 15 years ago, Freitag is kept on task by an alarming thought: “With tons of literature about concussions available, why aren’t today’s coaches, medical providers and parents better informed?” Doctor Cindy J. Chang, UC Berkeley Team Physician and Sports Medicine Specialist and CCC Co-Chair offers encouragement, say- ing the study of neuro-cognitive functioning is finally emerging from its closeted past. Peer-reviewed research, benchmark studies, modern imaging techniques allowing doctors to observe what is happening in an acutely injured brain, and professional athletes speaking out about the reasons behind their retirement, are chang- ing awareness. “Returning soldiers with blast injuries mean concus- sion clinics are springing up across the country,” she says.“ As a former head team physician for CAL’s 27 athletic teams and Chief Medical Officer for the London 2012 Olympic Games, Chang says the most vital scientific knowledge pertains to return- to-play. “If they have symptoms and return before their injury is resolved and have a second injury, they increase recovery time and their inability to return to sport and to school.” Although difficult, both Freitag and Chang advise parents to thoroughly question medical providers’ experience treating head injuries. Baseline testing, is helpful, but an incomplete diagnostic tool. Placing certified, trained personnel on the field; encouraging athletes to report; and advising teachers, parents and coaches on proper management of a young athlete’s return- to-play are most important. THE COACHES Shane Carney is Boys Varsity Soccer Head Coach at Campolindo High School and Director of Lafayette’s East Bay Eclipse Soccer Club. He errs towards caution; keeping one recovering player from heading (a term used for when the ball is in the air and a player hits the ball with the top front part of their head) during an entire season of practices and benched another all year, when persistent headaches meant doctors weren’t ready to clear him. “Any time I suspect a head injury, standard procedure is to see if there are any visible signs,” he says. “Players always think they're fine, so sometimes you have to step in and stop them, even if they're upset.” Las Lomas Program Director and Head Women’s Varsity Soccer Coach Jeremy Hull also coaches high school and club sports. In October 2012, his goalkeeper caught a blow to the head they at first thought wasn’t serious. Three minutes after the injury, she complained of a headache; seconds later, she could barely stand upright. An MRI showed a severe concussion, keeping her out of the game for months. Hull believes media attention is helping to change the “don’t say/still play” mentality. “Only in the last few years have athletes been will- ing to come forward and admit to head injuries,” he says. THE PARENTS The weeks after an actual injury are ter- rifying, parents attest. “The extreme fa- tigue and cognitive problems were the worst. Seeing my bright, high energy child so out of it was frightening,” says Walnut Creek resident Nancy Robey. Her son, Tom, suffered a concussion while playing lacrosse. After collapsing onto a bench, Tom was taken to the hospital, diagnosed with a concussion and given a treatment brochure. Robey wakened him every two hours for the first 24 hours and said a massive headache and sensitivity to light persisted for days. Five days later, he was still unable to concentrate and the family’s pediatrician advised them that the brain needed time to heal. It was over a month before Robey says “a spark of Tom’s old personality” appeared. “All parents need to have any blow to the head checked out.” Kristin Kisner, a Lafayette mother whose 13-year-old daughter, Jenna, was injured in a club sport competition cautions, “When you hear your child has a ‘mild’ concussion, know that mild is still serious.” Jenna never even had a bump, but she did have a head injury that kept her out of school for two weeks and out of action for even longer. Their family doctor told them to take all screen time away (the visual disturbance can increase the risk of seizures) and be prepared for a lengthy healing process. Today, both Jenna and Tom are on the road to recovery with watchful parents and professionals keeping close tabs on their condition. “The main takeaway,” Freitag says, “is that if a concussion happens, take a deep breath. There’s no evidence that a single, solitary concussion, well managed, causes long term dam- age. What’s important is that the brain needs to be treated and not re-injured while it’s healing.”

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